Cancer treatment and your heart

Transcription

1 Cancer treatment and your heart This information is an extract from the booklet Heart health and cancer treatment. You may find the full booklet helpful. We can send you a free copy see page 9. Contents How cancer treatment can affect your heart Radiotherapy Chemotherapy Targeted therapies (also known as biological therapies) Hormonal therapies Surgery for cancer Cancer research trials (clinical trials) How cancer treatment can affect your heart Only some cancer treatments affect the function of the heart. They may have an immediate effect on the heart or not cause heart problems until many years later. It s very important to discuss the risks and benefits of your treatment with your cancer doctor (oncologist) before you start it. The way that cancer treatments affect the heart depends on many factors, including: The treatment and total dose of the treatment. The age you have treatment. The risk is higher in older people or very young people. Children who have cancer treatment at a young age have a greater risk of developing heart disease later in life. If you have risk factors that can affect the health of your heart. For example, if you smoke or are overweight. You can help protect your heart during treatment by making healthy lifestyle choices, such as eating well and being phsyically active. Questions about cancer? Ask Macmillan Page 1 of 9

2 If you already have a heart condition, such as coronary heart disease or heart muscle damage, and have cancer treatment, you have a higher risk of developing further heart problems during or after treatment. Your doctors may not give you certain cancer treatments if they think they are likely to cause further damage to your heart. If you have more than one cancer treatment that is known to affect the heart. If you had previous cancer treatment that may have affected your heart and then you need further treatment that may also affect your heart. This could happen if you develop a new cancer or if your cancer comes back. On the next few pages, we list different cancer treatments that may have an effect on your heart. Talk to your cancer doctor if you re worried about any aspect of your treatment. If your treatment has finished and you have concerns about your heart health, visit your GP. If you don t remember the names of the specific cancer treatments you ve had, ask your cancer doctor or nurse to give you a list of them. Radiotherapy Radiotherapy is the use of high-energy rays to destroy cancer cells. Most people who have radiotherapy do not develop heart problems following treatment. Radiotherapy treatments will only affect the heart if the heart is in the area that s treated. This may include radiotherapy given to the chest to treat left-sided breast cancer. However, this is only likely to be a significant problem if the treatment was given over 10 years ago. Today, advances in treatment mean that radiotherapy for breast cancer is unlikely to cause significant heart problems. Page 2 of 9 Questions about cancer? Ask Macmillan

3 Radiotherapy can affect the heart in different ways. It can: change the inside of the blood vessels that supply the heart, making it easier for fatty deposits to collect, causing the arteries to narrow (coronary heart disease) damage the heart muscle, which makes it harder for the heart to pump blood efficiently damage the heart valves, so that they become too stiff and can t open properly, or may not close tightly enough and become leaky. The effect of radiotherapy on the heart may not be seen for 10 or more years after treatment. If you ve had radiotherapy and the area treated included your heart, make sure you lead a healthy lifestyle to avoid any further damage to your heart. This should include eating well, being phyiscally active, maintaing a healthy weight and controlling stress. It s sensible to have regular blood pressure and blood cholesterol measurements taken. You may also need to have an ultrasound of your heart (echocardiogram) carried out from time to time. This test records the rate, rhythm and electrical activity of the heart. Your GP can arrange these tests for you. If you notice any symptoms of heart disease, tell your cancer doctor or GP as soon as possible. Symptoms of heart disease may include: chest discomfort/tightness difficulty breathing, especially when exerting yourself or lying flat rapid or irregular heartbeat swelling of the feet and lower legs feeling weak, dizzy or having blackouts feeling more tired than usual. Questions about cancer? Ask Macmillan Page 3 of 9

4 Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Only a few chemotherapy drugs affect the heart. Your doctors will be able to tell you if the drugs you are having are likely to cause heart problems. Drugs called anthracyclines are the most common drugs to affect the heart. They include doxorubicin (also known as adriamycin), epirubicin, daunorubicin, idarubicin and mitoxantrone. These are used to treat breast cancer, some childhood cancers, soft tissue sarcomas, lymphomas and leukaemia. Anthracyclines can damage the heart muscle and make it weaker, but most people who have these drugs do not develop any heart problems. The risk of heart damage depends on the dose of the drug used and other risk factors. For example, it s more common in people over the age of 60 and in those who have high blood pressure or a high level of cholesterol in their blood. If anthracycline drugs damage the heart muscle, this can lead to heart failure, which may occur during or shortly after the chemotherapy. But it may not happen until more than 10 years after treatment. It s important that doctors spot any heart changes caused by anthracyclines. This is so they can treat them at an early stage and stop further damage to your heart. Your doctors will carry out tests before and during your treatment. These may include specific blood tests to detect early heart damage and an ultrasound of your heart. I had just finished my third cycle of chemotherapy for lymphoma when a routine echocardiogram and ECG showed problems with my heart. I was so sick from the cancer treatment that I had no idea anything was wrong. My treatment was stopped immediately and I was referred to a cardiologist who put me on medication. Kyle Page 4 of 9 Questions about cancer? Ask Macmillan

5 If your doctors find there are changes in your heart function, they may refer you to a cardiologist. This is a doctor who specialises in treating heart problems. You may need to have regular check-ups with the cardiologist to assess the health of your heart. Your cardiologist may prescribe heart drugs, such as ACE inhibitors or beta blockers, to protect your heart from further changes. Early changes in heart function may not cause any symptoms, but it s important they are treated so that more serious heart problems can be prevented. Other chemotherapy drugs Occasionally, other drugs such as cyclophosphamide, 5-Fluorouracil, capecitabine, paclitaxel and docetaxel can affect the heart. They can cause symptoms such as shortness of breath, chest discomfort (angina) or an abnormal heart rhythm, which may happen within hours to a few days after the treatment. In very severe cases, a heart attack may occur. If at any time when you are having chemotherapy, you have chest discomfort, tightness in your chest, shortness of breath, blackouts, dizzy spells or a feeling that your heart is beating too fast or too slowly, let your hospital team know as soon as possible. This is so that these symptoms can be assessed and treated quickly. If you do get any of these symptoms, your doctors will probably stop the chemotherapy drug and change you to another one that does not cause heart problems. Targeted therapies (also known as biological therapies) Targeted therapies are anti-cancer medicines that work by affecting processes that happen within cancer cells. Targeted therapy drugs are used to treat a number of different cancers. Some of these drugs can affect the heart. Trastuzumab (Herceptin ) Trastuzumab is given to reduce the risk of breast cancer coming back in women who have HER2 positive breast cancer. It s also used to treat advanced HER2 positive breast cancer. Questions about cancer? Ask Macmillan Page 5 of 9

6 In some women, trastuzumab weakens the heart muscle, which means the heart can t work as well as it did before (heart failure). It may not cause any symptoms, but in more severe cases, it can lead to breathlessness, chest discomfort and fatigue. The risk of trastuzumab causing heart problems increases if a woman is overweight. You will have tests, such as an ultrasound of the heart (echocardiogram), to check your heart function before starting treatment with trastuzumab, and at regular intervals during treatment. If your heart function changes, your treatment may be stopped temporarily and you may be referred to a cardiologist. Your treatment may be restarted once your heart function has improved or returned to normal. Women with existing heart problems are not usually given trastuzumab, as they are more likely to develop serious heart problems with treatment. Other targeted therapies Other targeted therapies can also affect the heart. They include: Pertuzumab (Perjeta ) and lapatinib (Tykerb ) These drugs are sometimes used to treat HER2 positive breast cancer. Pertuzumab may be given either with or instead of trastuzumab. Bevacizumab (Avastin ) This drug may be used to treat several different types of cancer, including bowel cancer, breast cancer and ovarian cancer. Sunitinib (Sutent ), sorafenib (Nexavar ) and pazopanib (Votrient ) These drugs are given to treat kidney cancer and a rare soft tissue cancer that usually starts in the stomach or small bowel, known as a gastrointestinal stromal tumour (GIST). Imatinib (Glivec ) and dasatinib (Sprycel ) These drugs are given to treat different types of leukaemia and GIST. Debrafanib (Tafinlar ) and vemurafenib (Zelboraf ) These drugs are used to treat a specific form of malignant melanoma. Page 6 of 9 Questions about cancer? Ask Macmillan

7 These drugs work by stopping cancer cells from growing. Some stop the cancer cells developing a new blood supply. They can cause high blood pressure in some people. Your blood pressure will be checked regularly during your treatment. Let your doctor know if you have headaches, nosebleeds or feel dizzy. A number of different drugs can be used to treat high blood pressure. Your doctor can tell you more about these.sunitinib, sorafenib and pazopanib can occasionally cause problems with the blood supply to the heart. If you have chest pain or breathlessness during your treatment, contact your doctor immediately. Some other targeted therapies can also affect the heart. Your doctor can let you know if the type of treatment you are having is likely to cause problems. Hormonal therapies Some cancers are influenced by hormones naturally produced within the body, and treatment is given to change the hormone levels. Some hormonal therapies increase the risk of heart problems. In women, hormonal therapies used to treat breast cancer may increase the amount of cholesterol in the blood. Rarely, this may increase the risk of heart problems and blood clots, such as a deep vein thrombosis (DVT). They include tamoxifen, anastrazole (Arimidex ), exemestane (Aromasin ) and letrozole (Femara ). In men, hormonal therapies to treat prostate cancer work by lowering testosterone levels. Low testosterone levels can cause a man to gain weight and increase the amount of cholesterol in their blood. This may also increase their risk of diabetes. All of these factors increase the risk of heart problems. Questions about cancer? Ask Macmillan Page 7 of 9

8 Surgery for cancer Having surgery for cancer often requires a general anaesthetic (when you are put to sleep before your operation), which can put stress on your heart. This is not usually a problem for a normal healthy heart. But if you have an existing heart problem, or if you have other risk factors (such as being overweight or having diabetes, or if you re a smoker), there s a risk that surgery and the anaesthetic together could result in damage to the heart. The risk may be small if you have minor surgery and only need to be asleep (anaesthetised) for a short time. If you have major surgery and need to be asleep for several hours, the risk can be greater. Some people can t have major surgery if it s likely to result in serious damage to the heart, such as a heart attack. Your doctor will explain the possible risks of surgery with you. Before any major cancer surgery, you will have tests to check your heart function and make sure you are fit enough for the operation. These may include a cardiac troponin test, which shows if your heart muscle has been damaged, or BNP (B-type natriuretic peptides) tests, which test if your heart muscle is under strain. If you re unable to have surgery because your heart function isn t good enough, your doctors will talk to you about other cancer treatments. Cancer research trials (clinical trials) Some people may be offered the chance to take part in a clinical trial as part of their cancer treatment. These trials may test new treatments such as chemotherapy drugs or targeted therapies. Doctors may not know about all of the effects these new drugs have on the heart when they are tested. If you take part in a clinical trial you will be monitored very closely during your treatment for any side effects. Make sure you ask your doctor about any known or possible side effects of the treatment, so that you can weigh up its benefits and disadvantages. If you develop any symptoms during the trial, including heart-related symptoms, tell your doctor or nurse so that these can be assessed and treated quickly. Heart-related symptoms are listed on page 3 of this booklet. Page 8 of 9 Questions about cancer? Ask Macmillan

9 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Heart health and cancer treatment, visit be.macmillan. org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN SEPTEMBER 2014 Planned review in 2017 Questions about cancer? Ask Macmillan Page 9 of 9